Update Lienholder/Bank on Vehicle Request

Request to Update Lienholder/Bank Information For Your Vehicle
1 Vehicle Owner Name    First Name   Last Name
2 Vehicle Owner Name   First Name  Last Name
Vehicle Owner Primary Contact Phone # Phone Number
Vehicle Owner Primary Contact Email Address Email
Mailing Address:

Street Address

Street Address Line 2

CityState

Zip Code
Are you (the person or entity submitting this request) anyone other than the vehicle owner such as bank, loan officer, etc?*
Requestor information if anyone other than the property owner:
Requestor Name First Name   Last Name
Requestor Company:   Prime Meridian Bank
Requestor Contact Phone Phone Number
Requestor Fax or EmailFax Number    /  Email
Do we need to send proof to anyone OTHER THAN the vehicle owner, the lienholder/bank, and requestor, if applicable, using the contact information above
Please list their name, and fax/email so we may send proof of coverage when finalized
Requested Effective Date of This Change:

MonthDayYear
Date
Are we replacing a current Loan?*
NEW Bank/Lienholder Address (were we will send insurance proof):

Street Address

Street Address Line 2

CityState

Zip Code
I received a letter from my bank indicating they need proof or they will force place insurance on my vehicle.
Upload Copy of Letter From Bank or take a photo using option below

Cancelof
Take Picture of letter showing where/ how we can send proof to them
Please attach any additional documentation if appropriate

Cancelof
Let us know if there are any other special requests, concerns, document requirements, etc so we can help and process this change as quickly as possible.
Please verify that you are human*
Remember, no coverages can be bound, changed, or cancelled until you get confirmation from a licensed agent of the McGinniss Himmel Insurance Agency, LLC. This form allows us to more accuratly and quickly help get you taken care of but submission of this form does not confirm or change your coverage. We OFTEN can respond to these within 2-4 business hours, but please allow us 24 hours (Monday-Friday) to review and contact you with options and confirmation of coverage.
Should be Empty:

Request to Update Lienholder/Bank Information For Your Vehicle